12 January - 20 June 2016

Intervention trials to increase fruit and vegetable consumption in children 5 years and under assessed

A Cochrane Review has examined interventions for increasing fruit and vegetable consumption in children aged five years and under. Eating fruit and vegetables in childhood has been found to be associated with a decreased risk of future chronic diseases such as cancer and cardiovascular disease.

A Cochrane Review has examined interventions for increasing fruit and vegetable consumption in children aged five years and under. Eating fruit and vegetables in childhood has been found to be associated with a decreased risk of future chronic diseases such as cancer and cardiovascular disease.  According the World Health Organisation globally 2.8% of death and 1% of disability-adjusted life years each year are attributable to inadequate fruit and vegetable intake, with low consumption responsible for 14% of gastrointestinal cancer deaths, 11% of all ischaemic heart disease, and 9% of all stroke deaths.  Previous research has suggested that eating behaviours in childhood often persist into adulthood.

Hodder et al. carried out a systematic review of interventions designed to increase consumption in children aged 5 years.  The team identified studies including randomised controls and cross over trials that compared two or more alternative intervention programmes or compared an intervention programme group with a control. A search was conducted using a number of electronic databases including MEDLINE and CENTRAL, as well as articles which were published between 2006 and September 2016, in three peer-related journals.  The scientists included 50 trials with 137 trials arms involving 10,267 participants.  Of the 50 trials, thirty investigated the effect of child-feeding practices in increasing child vegetable intake, eleven examined the impact of parent nutrition education, eight examined the impact of multicomponent interventions, and 1 examined the effect of a nutrition invention delivered to children. The authors note that “thirteen of the 50 included trials were judged as free from high risks of bias”.

The team report that child-feeding practices vs no intervention, results in a small increase in vegetable consumption. Children feeding interventions appeared to increase the eating of vegetables by 4.03 grams. With no intervention the children were found to consume 7.7 grams. The authors caution that the quality of evidence is low and long term follow up is required, as the majority of studies only had a period of follow up of up to six months.  Whilst the scientists report that there was no short term difference with parent education vs no intervention and multi-component intervention vs no intervention. Hodder et al report that of the 11 trials assessed, 4 studies investigated the long term impact of parent nutrition education intervention (12 months or longer), with only one trial reporting significant long term effect.  No long term trial assessed the long term impact of multicomponent intervention. 

In conclusion the team report that there was insufficient data for long-term effectiveness, cost effectiveness and unintended adverse consequences of intervention and note that "given the low-quality evidence, future research will very likely change estimates and conclusions.  Such research should adopt more rigorous methods to advance the field."

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